Massage
Receiving bodywork and Biomechanical Stimulation (BMS)
at the same time is an amazing experience. Additionally,
BMS not only helps mobilize the toxins released during
deep tissue work, it also causes the involuntary relaxation
of the muscle tissue allowing for a deeper and more
restorative massage.

Biomechanical Stimulation (BMS) as a therapeutic modality has
recently undergone a renaissance in athletic and physical
therapy circles. While much has been written about it, I believe
the full significance of its therapeutic application has yet to
be grasped. To more fully understand the potential benefits of
BMS, I believe we must understand the etiology of tremor and the
benefits of exercise, as BMS is indeed their physiological
involuntary recreation. This paper will discuss tremor, exercise
and BMS, as a means to further understand the potential
therapeutic roles of BMS in clinical practice.

Biomechanical Stimulation

Spencer Feldman
October 2004
Introduction

Biomechanical Stimulation (BMS) as a therapeutic modality has
recently undergone a renaissance in athletic and physical
therapy circles. While much has been written about it, I believe
the full significance of its therapeutic application has yet to
be grasped. To more fully understand the potential benefits of
BMS, I believe we must understand the etiology of tremor and the
benefits of exercise, as BMS is indeed their physiological
involuntary recreation. This paper will discuss tremor, exercise
and BMS, as a means to further understand the potential
therapeutic roles of BMS in clinical practice.

BMS Therapy

Let us first define BMS and give a short history. Traditional
BMS is a form of physical therapy where a patient stands on a
vibrating platform oscillating at between 18 and 50 hertz. This
creates a reflexive reaction of skeletal muscles in a chain of
small and rapid involuntary muscle contractions. In this way,
tremor is induced involuntarily in the body. Unlike electrical
muscle stimulation, which is painful in subjects with intact
afferent pathways, BMS is purely mechanical.

Discovered by Nazarov in the 1970’s, BMS was first utilized by
Soviet gymnasts in training for Olympic gold. BMS later began
being used by Russian cosmonauts for micro-gravity induced
osteopenia and muscle degeneration. While word of BMS spread,
for many years it was primarily used by elite athletes to help
increase the strength and coordination of the musculoskeletal
and nervous systems and to increase the rate at which athletic
injuries heal. Now however, BMS is being discovered as a therapy
by many practitioners outside of the physical therapy sciences,
and for a variety of conditions.

As BMS is a form of induced tremor, to gain a deeper
understanding BMS we must first study the nature tremor itself,
and so, on to tremor.

Tremor in Nature

We are all familiar with tremor at least in one form, and that
is the purring of cats. Cat purrs are created by false vocal
cords and based on spectral analysis, have three predominant
frequencies, namely 25, 50 and 120 hertz. What is not widely
known is that it is not only the felid family that purrs, and
that purring does not always indicate contentment.

Many other animals also exhibit purring including bears,
rhinoceros, whales, and dolphins. Furthermore, purring also
happens when animals are frightened or injured.

Since purring takes some considerable effort on the side of the
purror, and given that is not simply used as a method of
communication, we may conclude that there is some specific
benefit afforded the animal that purrs. This is supported by the
veterinary observations showing that animals that purr heal
injuries to their skin, bones, muscles tendons, ligaments and
lungs much faster than those that do not. Comparing domestic
dogs and cats sheds some light on the subject. The records of
31,484 dogs and 15,226 cats from 52 veterinary practices reveals
that the prevalence of arthritis and lameness in dogs as 2.4 and
3.1%. In cats it is not mentioned as being reported.1
Additionally, non-union of fractures in cats is rare.2 Finally,
in free skin grafting in dogs, the overlapped skin edges of the
graft usually become necrotic by 3 days postoperatively, and
need to be debrided. In cats, the grafts are usually viable even
after six days.3

Thus the question begs to be asked, what is it about purring
that is therapeutic, and in what ways can we as humans avail
ourselves of its benefits?

Tremor in people

While humans cannot purr per say, we do exhibit various forms of
tremor which is in some ways similar to purring. Although our
tremors are not audible like purring is, our tremors do vibrate
our bodies. Tremors manifest in humans in several categories.

Types of tremors

For the purposes of this paper, I will divide tremors into 2
categories, namely what I call homeostatic tremors and
non-homeostatic tremors. Homeostatic tremors are those tremors
that are beneficial to and planned for by the body.
Non-homeostatic tremors are tremors that have no apparent
benefit to the organism. The homeostatic tremors I label
thermoregulatory, orthostatic, toxic and psychogenic. The
non-homeostatic tremors would be associated with conditions such
as Wilson’s diseases (excess copper) use of beta-adrenergic
agonists, and cerebellar and Rubral tremor (brain damage).
Non-homeostatic tremors will not be discussed in this paper.

Thermoregulatory tremor

Thermoregulatory tremor, commonly known as shivering is a low
frequency (4-8 Hz) high amplitude muscle contraction in
conditions of hypothermia where temperature is raised through
increased metabolic rate.

Toxin induced tremor is well known in the case of drug
withdrawals and certain kinds of poisonings (heavy metals etc.).
It maybe that the increased circulation and metabolic rate of
tremor acts in a way similar to fever in helping the body more
quickly metabolize toxins.

Psychogenic Tremor

A well-known result of fear is physiologic shock causing the
immobility. Freezing in place is a useful response to a predator
only as long as the predator does not see the prey, but it is a
life threatening response once the predator sees the prey. It
may be that psychogenic tremor is the control mechanism to this
response to fear, allowing the ‘frozen’ animal to be ‘thawed’ as
needs require.

Tremor and etiology

Perhaps in knowing that tremor can be instigated by toxic
reactions, we will uncover toxic exposure as part of the
etiology of certain tremor related diseases. Already aluminum
and mercury have been associated with Parkinson’s and M.S. Could
it be that part of the tremor associated with these diseases is
not a symptom so much as the body’s attempt to detoxify itself?

Tremor and BMS therapy

Since tremor is known to be a response to low metabolism
(hypothermia) toxic exposure and psychological disturbances,
could it also be a therapy for them? Later in this paper we will
see that induced tremor (BMS) both increases metabolism
(increased VO2) and detoxification (through lymphatic
circulation). Whether induced tremor would be helpful in
breaking psychological patterns I leave for another day, but I
would however point out that many psychological conditions, such
as autism, which have sensory integration problems have rocking
as part of their symptomology. Could this be a form of
self-medication? Might an underdeveloped or uncoordinated
nervous system be benefited by induced tremor? Already Autism
and other diseases of development and the nervous system are
being treated with vestibular therapy such as spinning
platforms. Could it be that it is not the spinning itself but
the vestibular and proprioceptive stimulation that is curative?

In any case, we have seen that tremor is a very useful
physiological response in both animals and humans with a wide
therapeutic range. The ability of BMS to recreate tremor allows
us to gain the benefits of tremor without needing to induce
hypothermia, toxicity or fight.

Exercise and the human body

Now that tremor has been covered, we turn our gaze to exercise,
its benefits and relationship to BMS. The human body was
designed with, or evolved with, depending on your belief system,
exercise as part of its daily regimen. For thousands of years,
we as humans have had to work hard physically for our survival.
Then suddenly with the industrial revolution, machines began to
take the place of human labor. Now that our economy moved from
an industrial engine to an information engine, we work with our
bodies even less. The average job now consists of mental work
while the body is nearly stationary at a desk. How many of our
clients even know what an ‘evening constitutional’ is? Indeed,
even our entertainment is more often watching sports than
participating in them. We have paid and will continue to pay a
price for the immobility our newfound technology gives us. Enter
the age of the couch potato.
Seven important benefits of exercise

Exercise does many things but among the most important and well
understood are maintenance of bone density, muscle tone,
flexibility, metabolic rate, the movement of lymph fluid,
induction of deep sleep, and the generation of endorphins.

BMS, as will be shown, shares with exercise all of the seven
aforementioned benefits and as such, represents a viable
alternative or adjunct to standard resistance exercise (SRE).
BMS and bone mass

According to Turner, “Bone adaptation is driven by dynamic,
rather than static loading.”4 Thus BMS represents perhaps the
optimal way to increase bone density as it exemplifies the idea
of dynamic over static stimulation. The induced hyper-gravity of
BMS need not be intense as Ruben notes “Signals as low as 5
microstrains can be strongly anabolic if applied at 30 hertz”5
Additionally, bone stimulation takes very little time “Only a
short duration of loading is necessary to initiate an adaptive
bone response.”6 with “72 seconds per day being the saturation
point.”7
BMS and muscle strength
We now know that the strength training response is mediated by
both neurogenic and myogenic factors. In the first phase,
adaptation is characterized by an improvement of neural factors,
whereas the second phase is characterized by improvement in the
myogenic factors, which becomes more important as the adaptation
continues over several months.

BMS accomplishes both of these tasks but it accomplished the
neurogenic improvement especially well. Studies haven shown a
“substantial increase in muscle strength was observed after
three weeks of vibratory stimulation strength training when
compared with regular strength training”8. This suggests that
the improvement over regular strength training may be due to the
neurogenic complement.

BMS works in part by stimulating the proprioceptive pathways
(1a, 2a and probably 1b afferents). This vibratory stimulus
results in reflexive muscle contractions. The muscle contraction
elicited by BMS is involuntary and “induces strength gain in
previously untrained subjects within a short period of time and
without much effort.”9

Bosco continues noting that “the biological mechanism produced
by vibration treatment is similar to the effect produced by
explosive power training (plyometrics). The improvement of the
muscle performance after a short period of vibration training
has been quoted to be similar to what occurs after several weeks
of heavy resistance training.”10

BMS is particularly applicable for seniors as “ lower limb
explosive strength and performance capacity have been suggested
to be even more important determinants of falls (among the
elderly) than pure maximum strength.”11
BMS and flexibility

BMS has shown to improve flexibility significantly through
stimulation of the Golgi organs. “3 applications at 2 minutes
each with a 2 minute pause between the series leads to a
spontaneous increase in mobility of 10-15% of the muscle
length…”12
BMS and metabolic rate

While BMS does not raise heart rate or blood pressure as much as
standard exercising, it does increase metabolism. Ritwegger
reports that “Oxygen uptake and hence metabolism typically
increases during VE (Vibration exercise) with 26 Hz by about 5
mlO2 min-1 kg-1 body weight as compared with to squatting
without vibration”.13
BMS is also an effective aerobic workout as ”combination with
squatting performed until exhaustion increases VO2 to about 50%
of the aerobic capacity.”14 As clients become more obese,
exercise becomes more difficult leading to a vicious circle. BMS
allows for the increase in metabolic rate without any effort on
the part of the client and offers a way to break the feedback
loop between obesity and infirmity.
BMS and lymphatic flow

Lymphatic flow as the main route of detoxification for the
individual cells must be maintained for optimum health. The
Lymph, unlike the blood, does not have an active circulatory
system but relies instead on the movement of the muscles for its
proper functioning. Without muscle activity, lymph flow comes to
a standstill. BMS can stimulate lymph flow since “with
vibration, a vacuum is periodically created”15

This effect is pronounced at frequencies between 5 and 15 hertz.
While overlooked by most BMS manufacturers, these low
frequencies follow the guidelines set out by Vodder in his
Manual Lymph Drainage for the slow and gentle pulsing of the
tissue. Low frequencies are also known to “induce muscular
relaxation”. 16
BMS and Sleep
While there is no data on the effects of BMS on sleep per say it
is a well-known fact that physical exercise induces deeper sleep
than inactivity. Currently 15% of the U.S. population suffers
from sleep disorders. As an interesting aside, even short naps
taken on BMS devices at low frequencies are highly restorative.
BMS and endorphins

No data is available regarding the production of endorphins by
BMS as compared to exercise. Given that most subjects
“experienced the vibration loading as enjoyable and fatiguing”17
endorphins are the most likely explanation.

BMS and pain

BMS has a very strong effect on the mechanoreceptors (proprioceptors),
the small nerve branches that surround the muscle fibers and
give us our awareness of position, movement and weight. An
interesting effect of activation of the mechanoreceptors is the
inhibition of the nozioception (pain) and the closing of the
pain gate18. Thus BMS plays a very important role in the
perception of pain, not just due to the production of
endorphins, but also because of the suppression of the
nozioceptive pathways. Additionally, if endorphins are indeed
being produced as suggested, this offers a second mechanism to
lower the perception of pain.

Thus as we have shown, BMS is not only equal to SRE, but in many
ways is its superior. It can accomplish the same results in less
time and with less perceived effort than SRE. It is also
available to those with impaired control over their
musculoskeletal systems due to injury or inability.
BMS and other conditions

There are conditions that BMS has proven successful in treating
that exercise alone cannot. Some of these unexpected benefits
follow.

BMS and neural reconditioning

An exciting application of BMS is its ability to increase neural
coordination and efficiency. BMS has been shown to “…increase in
motor unit synchronization, co-contraction of the synergist
muscles, or increased inhibition of the antagonist muscles.”19
BMS also “induced an improvement of the neuromuscular efficiency
of the muscles involved in the vibration treatment.” 20
The fact that BMS also has a history of effectiveness with
Strokes, Parkinson’s and M.S. suggests that the improvement in
neural functioning may go beyond simply increasing coordination.
BMS may in fact stimulate nerve re-growth in all tissues of the
body. As such BMS may have a therapeutic role in the all neural
injuries.
Benefits to the elderly

The elderly have perhaps the greatest need for and the least
capacity for exercise. Given that “the risk expected when VE
(BMS) is applied in the elderly is negligible”21 BMS represents
an important breakthrough in the care of our senior population.

The following results22 with BMS speak for themselves.

143% improvement in physical function
41% improvement in pain
60% increase in vitality
23% improvement in general health
57% improvement in quality of walking as assessed by the Tinetti
test
77% improvement in equilibrium
39% decrease in time required to get up and go

Internal massage

While the musculature (and for those versed in visceral
manipulation, some of the internal organs) can be massaged by
hand, most internal organs cannot. BMS allows for the massage of
the entire body. All tissues, including the small muscles that
control the eyesight and hearing, bone marrow, internal organs,
glands and the entire connective tissue can be mobilized
simultaneously with BMS.

“Chest wall vibration in turn, has been used to enhance
pulmonary hemodynamics and O2 saturation in patients with
chronic obstructive pulmonary disease.”23
Brain wave entrainment

The lower frequencies used for lymphatic massage and muscle
relaxation also fall in the brainwave range (5-18 Hz Beta, Alpha
and Theta). Since the motor used to drive a vibrating platform
can, under the right circumstances, also create an
electromagnetic pulses equal to the physical pulses. As an
example, a 7.8 Hz physical vibration will also create a powerful
7.8 Hz electromagnetic frequency (Schumann resonance) and can
induce in the client Alpha waves (typically associated with
relaxation.) In this way while simultaneously relaxing the body
of the client (4-15 Hz), a practitioner can simultaneously:

* Put the client into a meditative space (4-8 hertz/Theta).
* Relax the client into a calm but ready state (8-12
hertz/Alpha).
* Focus the client into an active decision-making state (12-15
hertz/Beta).

Other benefits
Many other benefits have also been noted in the literature
including improvements in scleroderma and migraines24, glaucoma,
improved vision (1.5 to 2 diatribes)25, Parkinson’s disease,
strokes, M.S., cellulite, and joint mobility26. Adhesions caused
by scar tissue have also been effectively treated27. Vibratory
stimulation combined with a substantial effort was shown to
elicit movement in neuromuscular patient who were unable to
contract their paretic muscles28. Last, but not least, a
significant increase in the plasma concentration of testosterone
and growth hormone, whereas cortisol was decreased.29

BMS and hyperthermia therapy

Hyperthermic (sweating) therapies have been shown to be far more
effective when a patient exercises before the application of
heat. Often with hyperthermia therapy, niacin is also given to
create a histamine reaction, which increases membrane
permeability thus allowing toxins stored in the fat and
connective tissues faster egress into the sweat and out of the
body.

BMS given before hyperthermic therapies makes hyperthermic
therapies more effective at detoxification. This is because BMS
will both exercise the body passively, and if applied properly,
induce histamine release. At frequencies above 20 hertz, BMS
will, after a sufficient amount of time, stimulate histamine
release globally in the body when a patient is supine.
Working with the body

Many of the body’s organs have the ability to rid themselves of
irritants and toxins. They do this with the only means available
to them, namely exaggerations of their native activity. The
stomach for example has a natural churning motion that helps mix
the food with digestive juices. When the stomach is irritated,
this churning in the extreme results in emesis thereby ridding
the stomach of the offending substance. Likewise the intestines
have a natural peristaltic action that passes food down the
digestive tract. When the intestines are irritated, this
peristaltic activity is amplified and the resulting diarrhea
rids the intestines of their irritants. Lungs and sinuses
respond to irritants with coughing and sneezing, which can be
seen as simply an exaggerated form of breathing. When the
irritant is at the cell level such as an infection, the cells
increase their activity as well. We recognize this metabolic
increase as fever.

Medicine has learned from the body and has biological and
mechanical ways to mimic these detoxifying reactions. In the
case of certain poisonings, emetics are given, mimicking the
stomachs natural course of action. When a person is choking, the
Heimlich maneuver is applied which is in truth an externally
forced cough. While not in practice now, (and in fact actively
suppressed with drugs) doctors of old would induce fevers in
patients with blankets, both baths certain herbs and saunas to
help speed the course of an infection.

Muscles also have a way to flush out toxins. It is called
tremor. The muscles themselves are always in motion whether we
see it or not, even when we are at rest. This motion assists
with the movement of blood and lymph and gives us the gentle
oscillation that allows for proprioceptive awareness. In the
same way as any organ, when muscles are irritated, they respond
with an exaggeration of the only activities they know, namely
contraction and relaxation. This tremor increases the rate at
which blood and lymph flow through the muscles and helps to
carry away irritants and bring in needed nutrients.

As such, it is useful to consider tremor as the muscle’s way of
coughing or sneezing out an irritant. Taken from this
perspective, BMS, as an externally applied tremor is in many
ways, the Heimlich maneuver for the muscles.

When you see tremor in pathology, as yourself. Could it be an
attempt to remove an irritant? As in the case of shivering,
could the tremors be an attempt to locally increase metabolism
in poorly functioning tissue? Might is be an attempt to increase
circulation? How might the tremor we are witnessing be
beneficial in this circumstance? This may help explain, (along
with the ability of BMS to accelerate nerve growth), why
diseases that present with tremors (e.g. M.S., Parkinson’s etc.)
are helped by applying more tremor. It may be that the tremors
in some diseases are not part of the pathology, so much as the
body’s attempt to heal itself. Perhaps using drugs to reduce
tremors in certain diseases is as potentially counterproductive
as giving drugs to lower fevers during the course of non-life
threatening infections. Would we be wiser in some circumstances
to ally ourselves with the body’s tremor response, reinforcing
it externally rather than suppressing it?

Conclusions
BMS possesses a wide spectrum of benefits both physiological and
psychological. These benefits include increases in strength,
bone density, balance, flexibility, coordination, neural
function, growth hormone and detoxification ability. It also
includes the suppression of pain, the decreasing of cortisol and
reduction of psychological stress. Many of these benefits are
understood in the context of tremor, some are understood as a
form of exercise, and some are unique to BMS itself.

Massage
Receiving bodywork and Biomechanical Stimulation (BMS)
at the same time is an amazing experience. Additionally,
BMS not only helps mobilize the toxins released during
deep tissue work, it also causes the involuntary relaxation
of the muscle tissue allowing for a deeper and more
restorative massage.